Provider Demographics
NPI:1700280773
Name:IMPLANTABLE SUPPLIES
Entity Type:Organization
Organization Name:IMPLANTABLE SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARION
Authorized Official - Middle Name:
Authorized Official - Last Name:SOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-901-8658
Mailing Address - Street 1:605 QUEENS GATE
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-7221
Mailing Address - Country:US
Mailing Address - Phone:205-901-8658
Mailing Address - Fax:205-682-6057
Practice Address - Street 1:605 QUEENS GATE
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-7221
Practice Address - Country:US
Practice Address - Phone:205-901-8658
Practice Address - Fax:205-682-6057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-20
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL19417174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty